Method for delivery of prosthetic aortic valve
Methods of delivering a prosthetic aortic heart valve are disclosed. The disclosed methods include loading a prosthetic aortic valve in a collapsed configuration into a delivery sheath so that a selected point on the prosthetic valve is rotationally aligned relative to a long axis of the delivery sheath with a selected radiopaque marker on the delivery sheath, while under fluoroscopic imaging, rotating the delivery sheath about its long axis to align a selected radiopaque marker on the delivery sheath with the selected point on the native aortic valve in a fluoroscopic imaging plane, thereby establishing a desired orientation of the prosthetic aortic valve with respect to the native aortic valve in which the prosthetic valve commissures are rotationally aligned with commissures of the native aortic valve, further advancing the delivery sheath along its long axis until the prosthetic aortic valve is disposed inside the native aortic valve, and deploying the prosthetic aortic valve into an implanted state inside the native aortic valve with the prosthetic aortic valve aligned in the desired orientation with respect to the native aortic valve.
1. A method of implanting a prosthetic aortic valve in a native aortic valve of patient with a delivery sheath, the prosthetic aortic valve including a stent frame having an interior and three prosthetic valve leaflets mounted within the interior and joined at three respective commissures to provide unidirectional flow of blood through the prosthetic aortic valve, the method comprising:
collapsing the prosthetic aortic valve into a collapsed configuration;
loading the prosthetic aortic valve in the collapsed configuration into the delivery sheath so that a selected point on the prosthetic valve is rotationally aligned relative to a long axis of the delivery sheath with a selected radiopaque marker on the delivery sheath;
introducing the delivery sheath along the long axis of the delivery sheath into a vasculature of the patient;
advancing the delivery sheath until a distal end of the delivery sheath is disposed in an ascending aorta of the patient with the entire prosthetic aortic valve in a position above the native aortic valve;
while the entire prosthetic aortic valve is in the position above the native aortic valve, fluoroscopically imaging the native aortic valve with a fluoroscopic camera;
setting a position of the fluoroscopic camera to establish an imaging plane in which a selected point on the native aortic valve appears on a central axis of the image of the native aortic valve;
after the advancing the delivery sheath, and while under the fluoroscopic imaging, and while the entire prosthetic aortic valve is in the position above the native aortic valve, rotating the delivery sheath about its long axis to align the selected radiopaque marker on the delivery sheath with the selected point on the native aortic valve in the imaging plane, thereby establishing a desired orientation of the prosthetic aortic valve with respect to the native aortic valve in which the prosthetic valve commissures are rotationally aligned with commissures of the native aortic valve;
after the rotating the delivery sheath, further advancing the delivery sheath along its long axis until the prosthetic aortic valve is disposed inside the native aortic valve; and
deploying the prosthetic aortic valve into an implanted state inside the native aortic valve with the prosthetic aortic valve aligned in the desired orientation with respect to the native aortic valve.
2. The method of claim 1 , wherein the rotating the delivery sheath is a second rotating, and further comprising, before the further advancing the delivery sheath, initially rotating the delivery sheath towards the desired orientation to reduce the amount of rotation required during the second rotating.
3. The method of claim 1 , further comprising, before the introducing, placing the prosthetic aortic valve mounted in the delivery sheath into an introducer sheath with the long axis of the delivery sheath in a rotational orientation relative to the introducer sheath that ensures the prosthetic aortic valve will be at least substantially aligned in the desired rotational orientation after the advancing.
4. The method of claim 1 , wherein the prosthetic aortic valve includes a radiopaque marker.
5. The method of claim 4 , wherein the rotating the delivery sheath further includes aligning the radiopaque marker on the prosthetic aortic valve with the selected point on the native aortic valve in the imaging plane.
6. The method of claim 1 , wherein the selected point on the native aortic valve is one of a commissure, a cusp, a nadir of a cusp, or a coronary artery.
7. The method of claim 1 , wherein the setting the position of the fluoroscopic camera incudes referencing a CT scan of the native aortic valve on which the selected point on the native aortic valve can be identified.
8. The method of claim 1 , wherein the setting the position of the fluoroscopic camera incudes referencing a CT scan of the native aortic valve on which the selected point on the native aortic valve can be identified, identifying a fluoroscopic plane containing the selected point, and replicating the fluoroscopic plane for the fluoroscopic imaging.
9. The method of claim 1 , further comprising, before the setting the position of the fluoroscopic camera:
predicting an initial position of the fluoroscopic camera that will establish the imaging plane based on a CT scan of the patient; and
setting the initial position of the fluoroscopic camera.
10. The method of claim 9 , further comprising, after the setting the initial position of the fluoroscopic camera and before the setting the position of the fluoroscopic camera, injecting a small puff of contrast dye into the native aortic valve.
11. A method of implanting a prosthetic aortic valve in a native aortic valve of patient with a delivery sheath, the prosthetic aortic valve including a radiopaque marker and a stent frame having an interior and three prosthetic valve leaflets mounted within the interior and joined at three respective commissures to provide unidirectional flow of blood through the prosthetic aortic valve, the method comprising:
collapsing the prosthetic aortic valve into a collapsed configuration;
loading the prosthetic aortic valve in the collapsed configuration into the delivery sheath;
introducing the delivery sheath along a long axis of the delivery sheath into a vasculature of the patient;
advancing the delivery sheath until a distal end of the delivery sheath is disposed in an ascending aorta of the patient with the entire prosthetic aortic valve in a position above the native aortic valve;
while the entire prosthetic aortic valve is in the position above the native aortic valve, fluoroscopically imaging the native aortic valve with a fluoroscopic camera;
setting a position of the fluoroscopic camera to establish an imaging plane in which a selected point on the native aortic valve appears on a central axis of the image of the native aortic valve;
after the advancing the delivery sheath, and while under the fluoroscopic imaging, and while the entire prosthetic aortic valve is in the position above the native aortic valve, rotating the delivery sheath about its long axis to align the radiopaque marker on the prosthetic aortic valve with the selected point on the native aortic valve in the imaging plane, thereby establishing a desired orientation of the prosthetic aortic valve with respect to the native aortic valve in which the prosthetic valve commissures are rotationally aligned with commissures of the native aortic valve;
after the rotating the delivery sheath, further advancing the delivery sheath along its long axis until the prosthetic aortic valve is disposed inside the native aortic valve; and
deploying the prosthetic aortic valve into an implanted state inside the native aortic valve with the prosthetic aortic valve aligned in the desired orientation with respect to the native aortic valve.
12. The method of claim 11 , wherein the rotating the delivery sheath is a second rotating, and further comprising, before the further advancing the delivery sheath, initially rotating the delivery sheath towards the desired orientation to reduce the amount of rotation required during the second rotating.
13. The method of claim 11 , further comprising, before the introducing, placing the prosthetic aortic valve mounted in the delivery sheath into an introducer sheath with the long axis of the delivery sheath in a rotational orientation relative to the introducer sheath that ensures the prosthetic aortic valve will be at least substantially aligned in the desired rotational orientation after the advancing.
14. The method of claim 11 , wherein the delivery sheath includes a radiopaque marker.
15. The method of claim 14 , wherein the rotating the delivery sheath further includes aligning the radiopaque marker on the delivery sheath with the selected point on the native aortic valve in the imaging plane.
16. The method of claim 11 , wherein the selected point on the native aortic valve is one of a commissure, a cusp, a nadir of a cusp, or a coronary artery.
17. The method of claim 11 , wherein the setting the position of the fluoroscopic camera incudes referencing a CT scan of the native aortic valve on which the selected point on the native aortic valve can be identified.
18. The method of claim 11 , wherein the setting the position of the fluoroscopic camera incudes referencing a CT scan of the native aortic valve on which the selected point on the native aortic valve can be identified, identifying a fluoroscopic plane containing the selected point, and replicating the fluoroscopic plane for the fluoroscopic imaging.
19. The method of claim 11 , wherein the stent frame further including a portion at a lower edge thereof, and wherein the deploying the prosthetic aortic valve includes deploying the prosthetic aortic valve with the portion of the stent frame disposed adjacent to the location of conduction tissue of the native aortic valve so that the frame does not damage the conduction tissue.
20. The method of claim 19 , wherein the portion includes a cut-out, recess, or opening.
21. The method of claim 11 , further comprising, before the setting the position of the fluoroscopic camera:
predicting an initial position of the fluoroscopic camera that will establish the imaging plane based on a CT scan of the patient; and
setting the initial position of the fluoroscopic camera.
22. The method of claim 21 , further comprising, after the setting the initial position of the fluoroscopic camera and before the setting the position of the fluoroscopic camera, injecting a small puff of contrast dye into the native aortic valve.